A large complex hydrocele on the right which could be secondary to a pyocele. There is also a large complex, cystic mass arising in the head of the right epididymis that measures approximately 7cm in diameter. This could represent either hemorrhage or purulent fluid, both could give this appearence. The right teste is mildly prominent. There is also a large cystic appearing structure in the upper pole of the right testicle.

Final pathology report: Right orchiectomy; markedly enlarged right testicle measuring 6cmx4cm attached to a large, sac-like, thickened hemorrhagic tissue. The entire mass measures 15cmx10cmx3cm. There are hemorrhagic and inflammed necrotic areas with focal thick walled abscess surrounding the inflammed and enlarged testicle. The spermatic cord and the epididymis are involved in the inflammatory process. No evidence of tumor is noted.

Diagnosis: Large hemorrhagic inflammatory process surrounding and invading the right testicle.

Discussion: Epididymitis is an inflammation of the epididymis. It is the most common cause of scrotal pain and swelling. In 1998 it was the most common finding in an ER department, with 38 of 145 patients diagnosed with this condition. There is decresed echogenicity secondary to edema. Doppler findings may show increased flow to the area which helps to differentiate between this and a torsion. If an abscess is formed, complex cystic areas may be identified. In most cases it is unilateral. The above patient had an acute case of epididymitis with abscess formation to the degree that the tissue started to become necrotic.

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